February 02, 2009

Health care and the economic stimulus package

The biggest story in the country is the $819 billion stimulus package moving through Congress and what it means to the economy and ordinary Americans.

I’m going to zero in on a slice of the story today, focusing on important health care provisions.

Of course, the stimulus package is still a work in progress. The House passed a bill last week; the Senate is expected to act this week. As is typical, there are differences between the two chambers’ approaches and they’ll need to be reconciled.

Here’s what we know so far about $127 billion in proposed health care spending for the next two and a half years under the recovery package and the implications for Illinois:

MEDICAID HELP TO THE STATES. An extra $87 billion would go to the states to help fund Medicaid, a joint federal/state program that covers medical services for needy children and parents, the impoverished elderly and the disabled.

The stimulus package would lift federal government Medicaid payments to Illinois by 4.9 percent to 7.6 percent, bringing an extra $2.9 billion to the state by 2010, according to estimates by Center for Budget and Policy Priorities.

That extra funding is important because so many people are losing their jobs and employer-sponsored health insurance and slipping into dire economic straits. At the same time, states are losing tax revenues, making them less able to provide needed services.

MEDICAID COVERAGE FOR UNEMPLOYED. One way to help the unemployed is to take an existing public health program and temporarily expand it. That’s what the House wants to do with Medicaid at a cost of about $11 billion. (The Senate has not proposed a similar measure.)

States would have the option to add any of three new categories of eligible individuals:

1. Anyone currently receiving unemployment assistance or who had received benefits that ran out. There would not be an income test. (Experts note states may be reluctant to commit to such a broad benefit.)

2. Anyone fired from a job between September 2008 and January 2011 who met income eligibility standards set by the states. The applicant could not earn more than 200 percent of the federal poverty level ($10,830 for an individual; $22,050 for a family of four).

3. Anyone who was fired and is receiving food stamps.

This would be an important option for Illinois to consider as a way of helping single individuals or married couples without children who become unemployed. Currently, these people do not qualify for Medicaid in Illinois.

COBRA HELP TO THE UNEMPLOYED. Both the House and the Senate bills would help people maintain medical coverage after losing jobs by offering substantial subsidies for COBRA premiums. The price tag is an estimated $29 billion.

Under COBRA, people who become unemployed can continue employer-provided health insurance for up to 18 months, so long as they pay 100 percent of the premium cost—far too expensive for most people. COBRA is available to workers in firms with 20 or more employees.

The stimulus package calls for the federal government pay 65 percent of the COBRA premium cost for up to a year.

Those eligible would include anyone who loses a job between Sept. 1, 2008, and Dec. 31, 2009. Also, the package would allow people 55 and older to retain COBRA coverage (at their own expense) until they get another job with medical coverage or become eligible for Medicare.

In Illinois, the average cost of COBRA premiums for a family is $1,106 a month ($400 a month for an individual). The 65 percent subsidy would reduce the family premium payment to $387.10 a month ($140 for an individual).

In addition to Ms Graham's blog post, the current plan which passed the House includes significant funding for expansion of community health centers. Community health centers serve over a million people in Illinois and over 500,000 in the Chicago metro area, regardless of the ability to pay. Community health centers provide cost effective, affordable quality primary care right in people's neighborhoods.

The stimulus package, in its current form, could direct funds for current health centers to expand in two ways: to hire more staff (from physicians to lay health promotors) and via capital funding for bricks and mortar expansions.

These elements of the stimulus package will create jobs in health care as well as increases in services to those who may have lost their jobs and their health insurance.

There's more in health care, but maybe we can save that for another post.

Something seems very wrong with a plan that only provides extended health care benefits for people who lost their jobs after 9/1/08 ... I have been unemployed for well over a year and have sacrificed to pay my COBRA premiums and this legislation contains no umbrella/grandfather clause?

How can they extend emergency unemployment benefits 2 times in the past 9 months (with a 3rd extension coming at the end of February) for a total of 30 weeks of extended benefits and then only provide health care options for people who have been out of work for a minimum of 5 months??

This is nothing short of outrageous, especially when less than 20% of people even exercise their COBRA benefits because they can't afford the premiums.

there is too much pork in this stimulus package its designed to help the banks and the big companies not the poeple i agree on the medical and the unemployment but it has millions going to build infrastructure and roads birth control and money to rebuild the homeland security a new building and of course the millions they want to spend to put furniture in the home land security bldg... personally i think they are using a lot of this for their underground world look it up its under d.u.m.b defense under ground military base its more like a safe haven for the govt officials and the rich...

Hey Beth what do you want? They are talking about paying 65% of the COBRA premium which is only 102% of what your employer paid when you were working. Now you know what companies have been paying for your health insurance coverage. Seems like everybody wants something for nothing. Our country can't afford all of this stuff.

Subsidizing COBRA benefits makes economic sense. I was laid off on December 31, 2008, and subsequently diagnosed with a pre-malignant health condition. Fortunately, my severance package gives me three months of employer-subsidized (former employer) health benefits. In April 2009 I will have to pay the full monthly premium ($563) for single coverage. Hopefully I will be re-employed by then. If not, I will probably drop my COBRA health insurance as too expensive. I suspect that any new insurer will consider my pre-existing condition and levy a higher premium with a higher deductible; or not insure me at all; or issue a 6 - 12 month waiting period before covering treatment costs. We the unemployed already have plenty to worry about without the added anxiety of no health insurance coverage. The stimulus bill's COBRA provision will help millions of unemployed.

the unemployed need help! this bill must be passed.
the US workforce is NOT to blame for the financial crisis.

the 65% COBRA premium reduction should be grandfathered for those unemployed for OVER 1 YEAR! how long must people suffer for the greed of the CEO's who are still taking multimillion $ bonuses, and perks, beyond the average persons dreams.

I am 61 y/o and CANNOT FIND a job! I have been paying through the nose for COBRA for the past 16 months. why shouldn't I get a rebate of 65%?

in shopping for individual insurance I have learned that if you take more than 2-3 prescription medications, you are just about uninsurable! COBRA will be a cheaper option for me.

ANYONE who is unemployed for over a year, is suffering from DEPRESSION & ANXIETY. The insures tell the doctors not to treat you, with therapy, just give you an Rx, then they slam you for it!

I too will miss out on the 65% subsidy since I was laid off before 9/1. At 61 not too likely to get another job either. Been looking at private coverage but no one seems very interested in providing it even with high premiums. REALLY hope the COBRA extension for workers over 55 passes as part of the stimulus package! Does anyone know exactly where this provision stands in the Senate at present???

I wish the american public had a right to look at the stimulus bill before the people of congress. Well let's take over this country by getting rit of these old timers in office! No more corporate bailouts! Just I little advise next time you vote please take the time to research this person do not let the MEDIA make up your mind. Remember it is our children's future! Good luck everyone!

This bill is an earmark for the insurance industry and an insult to the 47,000,000 already uninsured.

The money for COBRA payments will be paid to the insurers! I heard Obama say that everyone will make sacrifices, but apparently that excludes insurers.

The folks who receive the government subsidy have received tax-free subsidies from their employers for years. This ends up being hush money for them, since they will have no incentive to get angry enough to demand real reform.

Bailing out those who've recently lost their jobs insults the 45,675,000 uninsured and 14,541,782 individually insured. These people frequently go without health care, and should be the first to receive subsidies to purchase health insurance, not last, if ever.

Wrongly, this is an attempt to throw a lot of money - $29,000,000 - so that people will think the bill helps improve health care. Wrong! It perpetuates the current system.

Judith, who proposed this part of the bill? What are her/his ties to the insurance industry? That would be valuable information.

to george you can see the full bill, it is posted on line.
to everyone else, especially those unemployed and over 60.

if a company policy is to offer health benefits to all employees, then we WILL BE discriminated against as we represent a risk to the overall payout of their health plans.

1. we should be allowed to have COBRA benefits from our previous employer(s) until we can get benefits from a new employer or join medicare.

2. we should be allowed a rebate of 65% of the premiums that we already paid, for the 1st 12 months also, just like those fired after 9/1/08.

3. what makes the government feel the "recesssion" began on 9/1/08 ? where did that date come from? there were forclosures and layoffs long before that!

4. this bill should also include a demand for re-payment from companies that squandered "BAIL-OUT" money on executive, bonuses, company parties, trips and other top executive perks! this is corporate theft, no different than anyone cought stealing. are the laws different for CEO's than for workers? If I used government money that way, for sure I'd be arrested for theft! a erfect example is FOOD STAMPS. you cn't use them to buy alcohol. but corporate bailout money can be used to buy vacations with open bars?

give that money back to the taxpayers!

how dare anyone in government even think of dening a layed off worker benefits, while these workers tax dollars went BACK TO THE VERY SAME COMPANIES THAT FIRED THEM, AND WERE USED TO PAY CEO'S BONUSES!

Americans should be mad as hell, and not willing to take it anymore. Taxpayers sre being used & abused.

I strongly suspect that neither side really knows what they're doing. The problem is simply too large, complex, and interconnected with economies of other nations, over which the US has no control. To fix most things in the universe, you have to get it to sit still at least for a short period of time. This is a dynamic situation. If we as a society actually knew what worked, and could establish a cause and effect relationship with any certainty, we would have done it by now. Don’t you think?

Benefits should be comparable to those of congressmen. Why do they get separate benefits, which are markably better than the common citizen? Example, they do not contribute to social security, they have their own retirement program., Yet when it is suggested that we "the people" are given a program similar to their's they object. Same holds true for health benefits. I have a hard time accepting this elitist attitude.

You have GOT to be kidding me. Of course the Chicago Tribune would support Obama and praise anything that the messiah does. TRUTH IS, the provisions in the health care part of this SPENDULUS package also DENY patients visits to their doctors for basic tests such as pap smears!
Women will only be allowed to get one pap test per three years. It will LIMIT the amount of testing patients can do and LIMIT the ability to treat patients and save lives.
THIS IS GOING TO PUT DOCTORS OUT OF BUSINESS and the US will end up with only foreign trained nurses and doctors who have substandard training. DON'T BLAME ME I VOTED FOR MCCAIN!!!

WOW, some happy, some unhappy! Me, I'm just mad! This health care that everybody is raving about is nothing more that one more step toward socialized medicine. Do you know that there will be a government "Zaar" if you please, appointed to act as a consultant? Do you know that at pre-determined ages, your doctor would have to contact this "government person" to see if you can have additional testing done for whatever ails you. If you are at that pre-determined age, that government employee can say no, you are to old, you need to learn to live with your ailments because we need the money for younger people. In other words, Grandpa, you're old and will die soon, get over it! Now, how do you like your new health care system? Personally, it SUCKS! Government has no business in our personal lives, but just keep electing those idiotic liberals and you will have absolutely no freedoms to enjoy. Have a good day.

One of the main reasons health care is so costly in the U.S. is because doctors have to pay criminally high insurance premiums because people are allowed to sue over anything as small as an ingrown toenail. People don't take their doctor's advice, something bad happens, and then they sue their doctor. Huh? And who do you think ultimately pays for that insurance?

You can hardly find an OB-GYN in the Las Vegas area anymore. Everyone's getting out because it's just not worth it.

Here's an idea: When awarding "punitive damages" (payment meant to "punish" the doctor), how about those monies go to charity, not to the plaintiff (who really doesn't get that much anyway, because so much goes to the lawyer). I mean, it still punishes the defendant, and isn't that supposed to be the point? Something tells me lawyers wouldn't push nearly as hard for those punitive damages.

Also, we need to put caps on damages. Some of these awards are just ludicrous.

Lower the number of lawsuits and you'll lower the cost of healthcare.

And that brings up another point. If the government is (basically) in charge of our healthcare, is that who we sue if there really is a legitimate claim for medical malpractice? I mean, with this health care package, the doctor will only be doing what the government says he has to do, right?

Looks like to me the COBRA extension until Medicare elgible for employees over 55 did not make it into the stimulus package adopted by conference. However, there is some language on page 386 of the bill about "EXTENSION OF COBRA BENEFITS" that talks about workers over 55 but I can not decipher it. Does anyone know what the story is here? I REALLY could have used this extension!

Even though it was scaled back to 60% coverage for 9 months, the new COBRA provision in the final stimulus package should help millions of laid off workers. Taking away this headache from families will mean a lot.

What about the people that got laid off prior to 9/1/08 and had to let go of their COBRA coverage at $470/month for singel coverage in order to live/pay rent, food,etc and this was a couple months before Obama got into office?

What happens to single individuals (w/o kids) who need insurance until they can obtain coverage from another full-time job/employer?

Major medical insurance basically doesn't cover anything exisiting. .. so therefore if you have to pay cash for your existing prescriptions plus the major med. insurance, one is back to the same place.. having to let go of major medical coverage and use your cash for your meds.

I can't be the only person experiencing this dilemma.

Where do you go for help w/ this? Would this be Category 1 in the above Medicaid recovery plan for state?

About this blog

Getting the medical care you need isn't easy. Resources can be hard to find. Weighing the costs and benefits of proposed interventions can be difficult. Choosing a doctor or a hospital, negotiating with your insurer, staying on top of treatment trends, getting the best care possible -- all these can be nerve-wracking. This blog will bring you useful information, connect you with important resources and highlight the stories of other people like you.